Cruel to be kind? Regional block before or after induction of general anaesthesia

Autor: J.A.W. Wildsmith, P.D.W Fettes
Rok vydání: 2002
Předmět:
Zdroj: Current Anaesthesia & Critical Care. 13:287-292
ISSN: 0953-7112
Popis: The question of whether to insert regional blocks before or after induction of general anaesthesia is controversial, but the debate based more on opinion than fact. The arguments for insertion after induction are: •There is no evidence that it is any more dangerous. •It leads to greater patient acceptance and comfort. •It provides better conditions for training. •The practice is medicolegally acceptable. The arguments for insertion before induction are: •Anaesthetized patients cannot report pain or paraesthesia when the block is performed, or adverse symptoms to test doses of local anaesthetic. •Why not perform the block first since this is standard practice in many centres? •Who will monitor the patient when the block is performed? There is no large randomized controlled trial comparing the safety of blocks before and after induction of general anaesthesia, and it is unlikely that there ever will be. However, a significant link between pain or paraesthesia experienced on needle insertion, and subsequent nerve damage has been observed. Also studies using nerve stimulators during peripheral nerve block have shown that paraesthesiae may be experienced without motor response. Both of these findings suggest that nerve block may be safer in awake patients. Although there is no direct evidence that performing blocks on anaesthetized patients is less safe, there is some indirect evidence to suggest it might be. If a block is to be performed on an anaesthetized patient there must be a good positive reason for this.
Databáze: OpenAIRE
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